Forearm fracture (peds): Difference between revisions
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{{Peds top}} [[forearm fracture]] | |||
==Background== | ==Background== | ||
*Mechanism: usually fall on outstretched hand (FOOSH) | |||
*Comprises 45% of all pediatric fractures | *Comprises 45% of all pediatric fractures | ||
*peak incidence 10-12 years of age in girls and 12-14 in boys | *peak incidence 10-12 years of age in girls and 12-14 in boys | ||
==Clinical Features== | ==Clinical Features== | ||
*Point tenderness, swelling, obvious deformity | |||
*Point tenderness, swelling, | |||
*Vast majority involve the distal third of the forearm | *Vast majority involve the distal third of the forearm | ||
| Line 11: | Line 12: | ||
===Pediatric forearm fracture types=== | ===Pediatric forearm fracture types=== | ||
*Diaphysis (20%) | *Diaphysis (20%) | ||
**Both bone fracture | **[[Both bone fracture]] | ||
**[[Greenstick fracture]] | **[[Greenstick fracture]] | ||
*Metaphysis (62%) | *Metaphysis (62%) | ||
| Line 25: | Line 26: | ||
**[[Galeazzi fracture]] | **[[Galeazzi fracture]] | ||
== | ==Evaluation== | ||
===Workup=== | |||
*Radiographs: | |||
**AP and lateral of forearm | |||
**Also consider AP and lateral of elbow and/or hand | |||
===Diagnosis=== | |||
*Clinically evaluate for: | |||
**Non-accidental trauma ([[Child abuse]]) | |||
**Puncture wounds over/near fracture site (open fracture) | |||
**[[Compartment syndrome]] (rare) | |||
==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Immobilization=== | |||
*Greenstick and complete fracture | *Greenstick and complete fracture | ||
**[[Sugar tong splint]] is preferred over simple [[volar splint]] | **[[Sugar tong splint]] is preferred over simple [[volar splint]] | ||
| Line 37: | Line 50: | ||
**>10 degrees of angulation in children >8 yr | **>10 degrees of angulation in children >8 yr | ||
**>15-20 degrees of angulation in younger children | **>15-20 degrees of angulation in younger children | ||
*Otherwise, ortho | *Otherwise, discharge with ortho follow up in 1 week | ||
===Specialty Management<ref>Orthobullets. Forearm Fractures - Pediatric</ref>=== | |||
{| class="wikitable" | |||
| align="center" style="background:#f0f0f0;"|''''' | |||
| align="center" style="background:#f0f0f0;"|'''Shaft / Both bone fracture''' | |||
| align="center" style="background:#f0f0f0;"|'''Shaft / Both bone fracture''' | |||
| align="center" style="background:#f0f0f0;"|'''Shaft / Both bone fracture''' | |||
| align="center" style="background:#f0f0f0;"|'''Distal radius/ulna''' | |||
|- | |||
| Age||Acceptable Bayoneting||Shaft Acceptable Angulations||Malrotation||Dorsal Angulation | |||
|- | |||
| < 9 yrs||< 1 cm||15°||45°||30 degrees | |||
|- | |||
| > 9 yrs.||< 1 cm||10°||30°||20 degrees | |||
|} | |||
==See Also== | ==See Also== | ||
*[[Forearm fractures]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pediatrics]] | ||
[[Category: | [[Category:Orthopedics]] | ||
Latest revision as of 23:09, 28 November 2019
This page is for pediatric patients. For adult patients, see: forearm fracture
Background
- Mechanism: usually fall on outstretched hand (FOOSH)
- Comprises 45% of all pediatric fractures
- peak incidence 10-12 years of age in girls and 12-14 in boys
Clinical Features
- Point tenderness, swelling, obvious deformity
- Vast majority involve the distal third of the forearm
Differential Diagnosis
Pediatric forearm fracture types
- Diaphysis (20%)
- Metaphysis (62%)
- Distal radius fracture (Colle's)
- Torus fracture
- Distal physis
- Salter-Harris I
- Salter-Harris II
- Salter-Harris III
- Salter-Harris IV
- Fracture with dislocation
Evaluation
Workup
- Radiographs:
- AP and lateral of forearm
- Also consider AP and lateral of elbow and/or hand
Diagnosis
- Clinically evaluate for:
- Non-accidental trauma (Child abuse)
- Puncture wounds over/near fracture site (open fracture)
- Compartment syndrome (rare)
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Immobilization
- Greenstick and complete fracture
- Sugar tong splint is preferred over simple volar splint
Disposition
- Consult ortho if:
- Rotational deformity
- >10 degrees of angulation in children >8 yr
- >15-20 degrees of angulation in younger children
- Otherwise, discharge with ortho follow up in 1 week
Specialty Management[1]
| Shaft / Both bone fracture | Shaft / Both bone fracture | Shaft / Both bone fracture | Distal radius/ulna | |
| Age | Acceptable Bayoneting | Shaft Acceptable Angulations | Malrotation | Dorsal Angulation |
| < 9 yrs | < 1 cm | 15° | 45° | 30 degrees |
| > 9 yrs. | < 1 cm | 10° | 30° | 20 degrees |
See Also
External Links
References
- ↑ Orthobullets. Forearm Fractures - Pediatric